Alterações do septo interatrial e acidente vascular cerebral isquêmico em adultos jovens

Abstract

AVCI criptogênico e FOP (razão de chance de 4,3; IC95% 1,7 -10,7). Foram diagnosticados apenas 5 casos de aneurisma do septo interatrial entre aqueles com FOP, todos classificados como AVCI criptogênico. Ta n t o a sensibilidade, especificidade e os valores preditivos positivo e negativo exibiram valores superiores a 85%, semelhantes, pelo menos com base nos intervalos de confiança. Conclusão: Constatamos, pela primeira vez em nosso meio, forte associação entre AVCI criptogênico e FOP. O DTC é importante re c u r s o diagnóstico nesse contexto, já que sua validade foi considerada muito boa, podendo ser útil no rastre a m e n t o de fontes emboligênicas, part i c u l a rmente alterações do septo atrial. Uma investigação minuciosa desses casos se impõe, notadamente pela perspectiva de fechamento do shunt intracardíaco.PA L AV R A S -C H AVE: forame oval, defeitos do septo interatrial, acidente cere b ro v a s c u l a r, ecocard i o g r a f i a transesofagiana, ultra-sonografia doppler transcraniana. Abnormalities of interatrial septum and ischemic stroke in young people ABSTRACT -O b j e c t i v e :To verify the frequency of patent foramen ovale (PFO) among patients with ischemic s t roke (cryptogenic or with a known cause) investigated by transcranial doppler (TCD) and transesophageal e c h o c a rd i o g r a p h y. Secondarily, to determine the diagnostic validity of the form e r, compared with the later m e t h o d . Method: R e t ro s p e c t i v e l y, 124 patients (<51 years old) with ischemic stroke were submitted to TCD and or transesophageal echocardiography. The patients were classified as cryptogenic stroke or not. Results: We could found an important association between cryptogenic ischemic stroke and PFO (odds ratio 4.3 -CI 95% 1.7 -10.7). Only five cases of interatrial septal aneurysm were diagnosed among patients with PFO. Sensitivity, specificity and positive and negative predictive values exhibited values upper of 85%, equivalents, at least based on confidence interv a l s . Conclusion: We could determine, for the first time in our c o u n t ry, a strong association between cryptogenic ischemic stroke and PFO. The TCD is a valuable diagnostic re s o u rce in this context since its validity was considered excellent. A detailed investigation in these cases should always be done due to the possibility of FOP closure.KEY WORDS: patent foramen ovale, atrial heart septal defects, stroke, transesophageal echocard i o g r a p h y, transcranial doppler.

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“…According to Mesa, et al [42], a greater mobility of the membrane of the oval cavity and a large degree of shunt contrast, as well as shunt at rest detected by saline-contrasted TEE, seems to identify PFO with ischemic stroke. Negrão, et al [45] considered the transcranial Doppler as another valuable diagnostic tool to detect abnormalities of interatrial septum.…”

Ischemic stroke and patent foramen ovale: case report

“…According to Mesa et al 14 , a greater mobility of the membrane of the oval cavity and a large degree of shunt contrast, as well as shunt at rest detected by saline-contrasted TEE, seems to identify PFO with ischemic stroke. Negrão et al 17 considered the transcranial Doppler as another valuable diagnostic tool to detect abnormalities of interatrial septum.…”

Αναγνώριση Και Εκτίμηση Του Μεγέθους Ανοικτού Ωοειδούς Τρήματος Με Τη Μέθοδο Του Διακρανιακού Υπερηχογραφήματος

“…Feldt et al, 1971). (Job et al, 1994) 84,6% 100% 100% 82,6% (Heckmann et al, 1999) 92% -97% - (Stendel et al, 2000) >85% >85% >85% >85% (Negrao et al, 2005) 92,85% 82,35% 89,65% 87,5% (Lange et al, 2008) 92.3%, 92.3% 85.7% 96% (Lao et al, 2008) 96,3% 96,8% -- (Kobayashi et al, 2009) 94% 96% 98% 89% (Zito et al, 2009) 94% 97% 98% 92% (Mangiafico et al, 2009) 96.8% 78.4%, -- (Caputi et al, 2009) 100% 75,8% 82% 100% (Orzan et al, 2010) 85% 90% 98% 53% (Maffe et al, 2010) Μάλιστα σε µια µελέτη 124 ασθενών µε διάφορα καρδιαγγειακά προβλήµατα, η ∆ΚΥ είχε καλύτερη επιτυχία από την ∆ΟΥ στον εντοπισµό µικροφυσαλίδων, χωρίς όµως να είναι δυνατός ο ακριβής προσδιορισµός της προέλευσης τους (Legras et al, 1999). Σε κάθε περίπτωση χρειάζονται επιπλέον µελέτες για να επιβεβαιωθεί η δυνατότητα χρήσης µόνο του ∆ΚΥ για τη διάγνωση του ΑΩΤ (Kronzon & Ruiz, 2010 (Caputi et al, 2009· Heckmann et al, 1999, µε την ∆ΚΥ να αποτελεί την µέθοδο πρώτης επιλογής, καθώς είναι µη παρεµβατική, γρήγορη και ασφαλής (Lange et al, 2008· Telman et al, 2003· Zito et al, 2009.…”